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BA
CK
CA
RE
The assistance of the Arthritis Foundation of Ireland
Association of Occupational Therapists of Ireland
Health and Safety Authority
Irish Society of Chartered Physiotherapy
National Irish Safety Organisation
Occupational Health Nurses Section of the
Irish Nurses Organisation in the revision
of this booklet is acknowledged.
BACKCARE
4 Introduction
6 Structure and Functions of the Spine
9 Types of Back Pain
13 Prevention of Back Pain
21 General Prevention of Back Pain
30 Back Care in the Home
35 Back Care for Children
39 Summary
3
TABLE OF CONTENTS
Back pain affects about 80% of the population in Western countries
and sadly the indications are that it would seem to be on the increase.
Why is this? With advanced technology and improvements in working
methods, we should expect to have fewer physical complaints.
This is not so.
The human body was built for movement, for physical activity, with
speed and precision being important factors. Children born today
are the same and have the same physical equipment as did our
pre-historic ancestors. Our ancestors chased after animals for meat,
climbed trees for fruit, walked miles in search of grain, in other words
they were extremely active. Later when they domesticated the wild
animals and cultivated fruit and grain they were still very mobile
because all work was done by hand. Squatting was the position of
choice, not only for rest, but also for tool making - our first industry.
Thus the facility for movement was utilised to the full. Mobility in all
joints was maintained and the stronger muscles were used in the work
for which they were intended, that is to propel the body in any
direction and lift whatever weight that was required to be carried.
When our development is traced through the ages, it is noticed that
we have carefully and methodically engineered our own physical ruin.
Technology has been to our benefit but the changes brought about
have created problems. We have failed to adapt adequately to those
changes through a diminished range of mobility.
4
INTRODUCT ION
Although we are without any documentation about the physical
wellbeing of our early ancestors, we can learn much from studying
primitive tribes in today's world. For instance the Aborigines in
Australia suffer very little from back pain and it is noted that the
low back curve in this tribe is less marked than in Europeans.
African tribes also reveal a very low incidence of slipped disc and
are seen to have an ample range of movement in the joints of the
lower back. Therefore, greater mobility and physical fitness through
manual labour is in fact what rewards underdeveloped peoples' in
terms of freedom from back pain.
This concept forms the background to preventative measures on
which this book is based.
SPINAL CURVES
Man structured to be on all fours.
Never adapted to upright position and consequently formed a low
back curve when standing.5
INTRODUCT ION
6
STRUCTURE
The spine is made up of a column of
bones called vertebrae, topped by the
skull and based on the pelvis.
Between the vertebrae is a
disc which cushions shock.
The disc is made up of an
outer ring of cartilage
and a jelly-like centre.
Neck or Cervical spine
Thoracic spine
Lumbar spine or
“Small” of the back
Pelvis
Jelly-like material
Thick outer ring
STRUCTURE AND FUNCT IONS OF THE SP INE
7
At the back of the spine are
small joints which are
responsible for movement
between the vertebrae.
These are held together
by ligaments. (see page 11).
The spine is strengthened andmade moveable by muscles.
This structure changes your
back from a rigid rod into a
moveable spine.
Moveable Joints
Muscles
STRUCTURE AND FUNCT IONS OF THE SP INE
8
FUNCTIONS
The spine carries the weight of the top half of the body and
transfers it to the pelvis. In addition it carries any load being
moved or handled.
Protection
The spine includes the spinal
canal which is a protective
channel for the spinal cord.
The cord is connected
directly to the brain.
Nerves emerge from the cord
between the vertebrae and
these control the movement
of the trunk, arms and legs,
and convey all sensations.
Discs cushioned between the vertebrae, bound by ligaments and
muscles, allow movement and flexibility. Without discs the spine
would be like a bamboo and we could not bend forward, backward,
sideways or look behind us.
Spinal CordNerves
STRUCTURE AND FUNCT IONS OF THE SP INE
9
There are over 100 accepted causes of low-back pain (or pain in the
"small of the back"), with wear and tear being the most common
cause of pain.
MECHANICAL PROBLEMS
Slipped Disc (or prolapsed
intervertebral disc):
This is caused when there is a
weakness or tear in the outer ring
of the disc allowing the jelly like centre
to burst through.
When this happens the contents
of the disc will press on one of
the nerves as it leaves the spinal
canal causing pain to be felt
elsewhere - for example Sciatica
is caused by the disc pressing
on the sciatic nerve.
Damaged Disc
Sciatic Pain
Distribution
TYPES OF BACK PA IN
10
WEAR AND TEAR
(Arthritis or Degenerative Disease)
Wear and Tear can affect the joints between the vertebrae as well
as the moveable joints at the back of the spine. The cartilage
or smooth covering of the joint becomes roughened and worn
with spikes of bone growing out from the side of the joint.
This prevents the joint from moving freely and leads to stiffness.
In conjunction with wear and tear the discs may become thinner
and the spikes of bone may press on nerve roots as they leave
the spinal canal causing pain or such sensations as pins and
needles or numbness.
Wear and Tear changes in the spine can be noticed from as early
as 25 years of age or even younger if there has been an earlier injury.
However, many of these changes cause few problems and where they
do they are often for only a short time.
There are a number of causes of backache due to excessive wear
and tear - for example an earlier injury, heavy physical work over
a long period, being overweight and lack of fitness.
Strained Muscles (Lumbago)
Muscles are strained by over loading. This is usually caused by
a sudden or unexpected movement, like catching a falling object.
Muscles are more easily strained if you are not fit, or do not warm
up before taking physical exercise, or when muscles are tired.
TYPES OF BACK PA IN
11
Strained Ligaments
Ligaments prevent excessive
movement in all joints
including those
of the spine. They can be
injured when a joint is
stretched to its
limit and held there too
long, or repeated too often.
Internal Problems
Backache is not only caused by something being "wrong" with your
"spine". Sometimes disorders of the internal organs can cause
backache - for example kidney stones or injury to the kidneys,
gall stones if they block the tubes of the gall bladder, gynaecological
(or "female") problems, or shingles.
EMOTIONAL PROBLEMS
Backache can sometimes be aggravated by emotional problems.
Because of the interaction between mind and body, we need to
be aware of the role of our emotions in the health of our backs.
Many back problems are the result of, or made worse by, chronic
daily stress. Under prolonged stress the body gives way eventually and
the stress earns a new label - "back problem".
With depression, worry, anxiety, discontentment or unhappiness,
normal aches and pains or unpleasant sensations become more
obvious. Minor discomforts now become back pain.
Ligaments
Spinal Cord
Discs
TYPES OF BACK PA IN
12
OTHER CAUSES
Back pain can be caused by the following conditions:
Tumours, T.B., Congenital Abnormalities, Osteoporosis,
Inflammatory conditions and so on.
These only account for 5% of all back pain.
TREATMENT
If you have back pain you must seek professional advice. Only those
qualified to do so, can tell you if the cause of your back pain is
because there is something wrong with your spine, or if the pain is
caused by something else, for example a disease or an emotional
problem. Therefore, treatment without first having seen a health
professional may make matters worse.
IMPORTANT
An early visit to your health professional may help to prevent
prolonged back pain.
TYPES OF BACK PA IN
13
POSTURE
Good posture is any position which allows
good use of the body for a specific task and is
comfortable for as long as the position is held.
Even though bad posture may not cause any
discomfort, continual poor posture will in the
long term cause back pain.
The curve (or "small") of the back is just
above the pelvis. When standing, this curve is
naturally present and varies from
person to person. The curve, which is
normally inwards, can be altered by changing
the tilt of the pelvis. An increase in the curve
for a prolonged time or frequently for shorter
times causes pain.
For many of us, our lifestyle is not conducive
to maintaining good posture. Our joints are
not adequately flexible and our muscle
strength is not in balance.
The best posture we can hope for in the
upright position is where the ear is over
the shoulder, hip, knee and ankle.
Most of us cannot achieve this alignment
mainly because of tight hamstrings and
tight upper lumbar spine coupled with
weak tummy muscles.
PREVENT ION OF BACK PA IN
14
The function of the curves of the spine is
to maintain balance and facilitate mobility.
They are not structured to be load bearing.
The best exercise to ensure they function
well is long stride walking, making sure to
straighten each knee as the opposite leg
moves forward.
In summary, good posture is the most
important way to preventing back pain.
POSTURES
Standing
If you stand or walk a lot,
low-heeled shoes are necessary
to facilitate good posture.
To relieve strain on the back,
when possible get one foot
supported higher than the other.
For example, when waiting for a
bus, put your foot up on
something and change from one
foot to the other occasionally.
When standing in your workplace, place one foot on a ledge or a stool
underneath your work surface to relieve pressure on your back.
PREVENT ION OF BACK PA IN
15
Another way to prevent back strain when standing is to have the
working surface at the right level, this is half way between the wrist
and waist when standing with your hands by your side.
SITTING
Sit with your knees higher than your hips.
If necessary, use a foot rest. This ensures that the
spine is resting in the optimum position
• Choose a chair that is the correct height for you.
• Sit in a chair with proper support for your
lower back.
• Choose a chair with arm rests - not too high
or not too low.
• Posture and sitting position are very important when
working at a desk or table. Always ensure that:
- You have a chair of correct height
which supports your lower back.
The best seat height allows your
elbows to be about one inch
above your desk.
- Reading stands or V.D.U.
equipment are flexible and
adjustable, so that you do not
have to bend over your desk or table.
(For further information, please consult the Guidelines on the
Health and Safety of Office Workers, published by the
Health & Safety Authority).
PREVENT ION OF BACK PA IN
16
LYING
Have a firm bed. When you are
lying down (whether on your
back or on your side) bend
your knees as this is
the most relaxed position for
your back. The pillow should
support your neck and allow it to rest in
a balanced position. A feather/fibre pillow is
best because it conforms to the shape of your neck.
When getting up from lying -
roll onto your side, use your
arms to push up and let your
legs out over the side of
the bed.
WHEN DRIVING
If your car seat is too deep
(from front to back) and the back of the seat does not support you
properly, fill the space with a small cushion or use a back rest.
The best position for the back rest is in the upright.
PREVENT ION OF BACK PA IN
Seated properly, your knees
should be higher than your
hips - if this is not so, adjust the
seat forward and for comfort's
sake place a small cushion
under your thighs.
If going regularly on long
journeys it helps to stop and take
a little exercise to relieve the
stress of prolonged sitting.
When getting out of the car, swivel your whole body towards the
door. Slide your feet onto the ground and stand up.
HANDLING Lifting
Always follow these basic principles when lifting regardless of whether
the object is heavy or light:
• Assess the task
- Area
- Load
• Bend the knees
• Broad stable base
• Back straight, though not
necessarily vertical
• Firm Palmar Grip
• Arms in line with trunk
• Weight close to the
centre of gravity
• Point feet in the direction of movement17
PREVENT ION OF BACK PA IN
18
Apply the basic principles to five basic lifts:
Lifting to and from:
1. Floor
2. Bench
3. Height
4. Pulling
5. Pushing
If the load is too heavy - GET HELP! or
use a mechanical aid e.g. a trolley.
CARRYING
Use the same principles for carrying as
you would for lifting but also remember
that if you have a load to carry, balance
your body by:
• Carrying two small loads
rather than one large one,
for example, always carry
two small shopping bags
rather than one large
heavy bag.
PREVENT ION OF BACK PA IN
• If the load cannot be divided,
hold it close to the body with
a firm grip in both hands.
Make sure that you can see
over the load.
Pushing and Pulling
When pulling or pushing - keep your
back straight, although not necessarily
vertical, bend at the hips and knees
using your leg rather than your arm
or back muscles to move the object.
Pushing is easier as you can easily see
where you are going.
19
PREVENT ION OF BACK PA IN
20
Reaching
If you must reach overhead - keep
your knees slightly bent and tuck in
your chin. If this is not possible,
use a stool or a step. Reduce the
weight to be lifted if lifting over waist
level. Avoid over-extending.
MANUAL HANDLING AT WORK
If your work involves lifting, putting
down, pushing, pulling, carrying or
moving a load which might involve a risk of back injury, the Manual
Handling Section of The Safety, Health and Welfare at Work (general
Application) Regulations, 1993 apply to your workplace. This is the
responsibility of your employer and the legislation is enforced by the
Health & Safety Authority.
PREVENT ION OF BACK PA IN
21
FITNESS
Fitness is important in the prevention of back pain. There are four
aspects to physical fitness:
Cardiovascular or Aerobic Capacity: It is a definite advantage to train
the heart to pump blood efficiently and without effort.
Strength: Muscle strength means that more muscle fibres are primed
to work. Strength is increased by high loading, low repetition exercise.
Endurance: Means that muscle fibres work in a relay system.
When energy of some fibres is spent, others take over.
Endurance is increased by low loading, high repetition exercises.
Flexibility: This is particularly important in backcare and in
particular, the safe performance of handling skills. The human frame
is built to perform in a certain way, but the soft tissue structures viz:
muscles, tendons, ligaments etc. will become shortened when their
potential range is not realised or maintained.
Appropriate flexibility will allow us to get into a safe position
for activity, so our body structure can be utilised in the way it
was intended i.e. with the limbs doing the work and the trunk
protecting the vital organs.
Everybody, regardless of age or stiffness, can learn to stretch and
doing exercises should become a way of life. The following exercises
will benefit safe physical performance and can be done at any time.
GENER AL PREVENT ION OF BACK C ARE
22
Muscles are stretched so they are lengthened to their normal range
of mobility. This range is determined by the structure of the joints
over which they pass. Exercises must be done slowly. Sudden jerky
movement into pain is not only ineffective but may seriously
damage tissue.
METHOD
Take up position where tension is felt and hold for ten seconds to
allow tissues adjust to the position. It is important to go to the point
of mild tension. As the tissues adjust, the tension subsides. If not, ease
back to where tension is comfortable. This is the easy stretch. When
tension has eased, move slowly into the developmental stretch where
tension is felt again. It is this phase that increases flexibility. Breathing
should be slow, rhythmical and controlled.
NEVER BOUNCE OR JERK
GENER AL PREVENT ION OF BACK C ARE
23
EXERCISES
1. Lower Lumbar Spine
Starting Position: Lie on your
back with your knees bent up
and feet flat on the floor.
Bring both knees up towards your
chest. Place both hands around your
knees and gently but firmly pull the
knees as close to your chest as you
can. When you feel tension, hold for
ten seconds. Pull a little further and
hold for ten seconds. Return to the starting position.
Relax. Repeat the stretch 5 -10 times.
2. Upper Lumbar Spine
Starting Position: Lie on your back
with your knees bent up and feet
flat on the floor.
Bring both knees up towards your
chest. Place both hands around
your knees and gently but firmly
pull the knees as close to your chest
as you can. Next, raise your head and shoulders towards
your knees. When you feel a little tension, hold
for 10 seconds. Pull a little further and hold for 10 seconds.
Return your head to the starting position while still holding
your knees. Relax. Repeat the stretch 5 -10 times.
GENER AL PREVENT ION OF BACK C ARE
24
3. Hamstring - Lower End
Starting Position: Stand, half sitting
with one leg along a bench or table.
Your knee should be straight
and your hands behind your back.
Lean forward at the hip joint,
keeping your back straight. When
you feel tension behind your knee,
hold for 10 seconds. Move forward
at the hip a little further and hold
for a further 10 seconds. Return to
the starting position and repeat
with the other leg. Do the exercise
5 - 10 times.
4. Hamstring - Upper end
Starting Position: Lie on the floor
with both knees straight.
Bend one knee onto your chest,
pulling with your hands placed
underneath your knee. Anchor
your knee towards the shoulder
of the same side, then attempt
to straighten your knee joint.
When you feel tension on the back of your upper thigh, hold for
10 seconds. Straighten the knee a little further and hold for
another 10 seconds. Return to the starting position and repeat
with the other leg. Do the exercise 5 -10 times.
GENER AL PREVENT ION OF BACK C ARE
25
5. Calf Stretches - Lower End
Starting Position: Stand in front
of a bench or table with your feet
apart and inner borders parallel.
Bend your knees, keeping your
heels on the floor and direct
your knee over your middle toe.
When you feel the tension
above your ankle hold for 10
seconds. Bend further and hold
for a further 10 seconds. Return
to the starting position. Relax.
Repeat the stretch 5 - 10 times.
6. Calf Stretches - Upper End
Starting Position: Stand in front
of a bench or table with your feet
apart and inner borders parallel.
Lean your body weight forward,
keeping your heels on the floor
and trunk and legs in a straight line.
When you feel the tension below and
behind your knee hold for 10 seconds.
Lean further forward and hold for
a further 10 seconds. Return to the starting
position. Relax. Repeat the stretch 5 - 10 times.
GENER AL PREVENT ION OF BACK C ARE
26
7. Ileo-Psoas/Quadriceps
Starting Position: Kneel on the floor
and sit back on your heels.
Place your hands on the floor
underneath the shoulders.
Thrust your hips forward
raising your seat from your
heels. When you feel tension,
hold for ten seconds.
Return to starting position.
Relax. repeat the stretch 5 - 10 times.
8. Trunk Rotators
Starting Position: Sit on the floor
with one leg crossed over the other
and your foot by your knee.
Turn to the side of the bent
knee and aim to get your
shoulders approximately 90°
to your hips. When you feel
tension hold for 10 seconds.
Pull a little further and hold for 10 seconds. Return to starting
position. Relax. Repeat the stretch 5 -10 times.
GENER AL PREVENT ION OF BACK C ARE
27
9. Abdominal Strengthening Exercises
A. Starting Position: Lie on the floor
with both knees bent and arms
off the floor but parallel to it.
Lift your head and shoulders
towards your knees as far as
possible without lifting the small
of your back off the floor.
Hold for a couple of seconds.
Ease the hold - but don't let your head and shoulders move
more than 1/16th of an inch. Repeat in triple slow time to reach
25 repetitions. If this causes discomfort in your neck place
one hand behind your head.
B. Starting Position: Lie on the
floor with both knees bent,
ankles crossed and your finger tips
resting on your shoulders.
Raise your knees towards your
shoulders and feel the hip bones
move towards your ribs. Ease the
hold - but don't let your head and shoulders move more than
1/16th of an inch. Repeat in triple slow time to reach 25 repetitions.
GENER AL PREVENT ION OF BACK C ARE
28
10. Quadriceps Endurance Exercise
Starting Position: Sit by the wall
with your feet thigh distance from
the wall and your knees at 90°.
Count in triple slow time and
take note of the number you
reach when you could not
possibly go any further.
Rest for a couple of minutes
and repeat. This exercise
should be done once daily
increasing your count by
2 - 3 every other day until
you can hold the position
for a minute.
WEIGHT CONTROL
Being overweight prevents us using the body in the most efficient
manner. In addition to increasing the load on weight bearing joints,
it also causes us to carry loads on joints not designed for that
purpose. Increased weight usually increases the low back curve which
in turn increases the wear and tear on the small joints of the spine.
(see page 14).
GENER AL PREVENT ION OF BACK C ARE
29
OSTEOPOROSIS
Osteoporosis is a condition which very often only becomes evident
in later life. However, the condition is caused much earlier in life
and can be largely preventable.
Osteoporosis is characterised by a loss of bone mineral density,
and demineralisation of the bone, which in turn may increase
the risk of back pain and fractures.
Adequate diet with calcium intake combined with exercise are the
means of prevention. However, over-training in female athletes
may also cause the condition.
A person's maximum bone density is achieved by the age of 25 -30
years. If a person is deficient at this time, it is unlikely that they will
regain this bone mineral density later.
People at greatest risk of developing osteoporosis later in life are those
who have Eating Disorders and those who lead sedentary lives.
GENER AL PREVENT ION OF BACK C ARE
30
Running a home involves lifting, carrying, bending, pulling,
pushing and working at different levels. Constantly performing
these activities incorrectly can cause back pain.
Plan worktops and cupboard space efficiently so that utensils
are easily at hand.
POSTURES
Standing
As so many household activities are done standing, it is very
important to have the worktops at the correct height - this is midway
between the wrist and the waist when standing with the arms by the
side. Remember, kitchens today can be made to measure.
When the worktop is too low, unnecessary strain is not only put
on the lower back, but also on the neck, shoulders and arms.
The ideal working conditions are not always possible, however,
the working area can be adapted with imagination, for example:
• If the kitchen sink is too low, place an upturned basin
in the sink and place the washing bowl on the top.
• Remember the ironing board is adjustable - why not sit?
As so much time is spent standing, careful attention should be given
to footwear - bedroom slippers should never be worn all day, however,
a one inch to one and a half inch heel is the most suitable.
BACK C ARE IN THE HOME
31
To rest your back while working in a standing position,
place one foot on a step or open a cupboard and place
one foot on the shelf inside the door.
Never stand if you can sit, for example ironing, preparing
vegetables, mixing cakes and so on.
Sitting
A high stool is a must in a kitchen. If the task does not allow you to
sit on a chair, using a high stool allows you to put your back into a
better position.
Lifting
Always apply the principles of lifting as given on page 17 of this book.
Where possible avoid lifting objects from the floor, for example
place the empty washing basket on a chair before filling it
and so avoid unnecessary bending.
The same principles apply when lifting from chair or worktop.
Carrying
Use the same basic principles. (see page 18).
Lifting To and From a Height
When reaching to a height, keep your knees slightly bent.
Rather than reaching overhead, use a set of firm steps.
BACK C ARE IN THE HOME
32
Pulling and Pushing
Use same basic principles. (see page 19).
When pulling or pushing, for example when moving furniture, keep
your back straight although not necessarily vertical.
EVERYDAY ACTIVITIES
There are many everyday activities that need special attention,
for example:
Shopping
Shopping poses many back problems such as filling the shopping
trolley, lifting shopping bags from the check-out to the trolley and
then from the trolley to the boot of the car or carrying the shopping
to the bus.
• Divide the load between both hands.
• If using your own shopping bag on wheels, keep it close to
your body to avoid unnecessary twisting.
• If you have a car and it has a deep boot, divide your shopping,
rest the load on the edge of the boot and then lower it in by
bending the knees, while keeping a broad base.
BACK C ARE IN THE HOME
33
Bed Making
Bend your knees, when tucking in the bed.
Laundry
When filling and emptying a front loading
machine or dryer - take care to bend the knees
and change direction by moving your feet.
Vacuum Cleaning
Remember these two principles when
vacuum cleaning:
• Relax your knees and keep your feet apart.
This will mean that your legs are doing the work
and not your back.
• Slide the vacuum cleaner along the carpet instead of
pressing down or "digging" into the carpet.
Cleaning out the Fire Grate
Kneel on both knees and get as close to the
grate as possible when removing the ashes.
BACK C ARE IN THE HOME
34
Lifting the Bin
The standard bin should be lifted by two people. If two people are not
available, use a smaller bin and apply the principles for lifting.
(see page 17).
Children in the Home
• When using a bath to bathe a baby,
always kneel.
• Stop carrying the baby in a front
sling as soon as head control is
good. Then carry it in a back pack.
• Choose a buggy that is light,
easy to fold and has a high handle.
• Bend your knees to lift the child
from the floor.
• Choose a cot with a drop-down
side to make it easier to lift the
child in and out.
PREGNANCY
All the foregoing principles of back care apply, as pregnancy
invariably causes backache, especially in the later months.
More care must be taken to avoid extra strain on the
lower back during this time.
Additional information may be obtained from your doctor or
maternity hospital.
For further information please consult the Pregnant at Work booklet
published by the Health and Safety Authority.
BACK C ARE IN THE HOME
35
If your posture is good, you look good and feel good. To prevent
Postural Problems in later life, it is essential to instill in children the
practice of good posture.
You, as a parent or teacher, have a responsible role to play in this
aspect of education.
Prevention is better than cure and proper training in these formative
years can offset much pain and physical discomfort in adult life.
Persistent back pain in children should be investigated.
POSTURE
Standing
The feet are the key to good posture in standing, so watch out for:
• All young children have flat feet and this usually corrects as the
child develops. However, if this persists and is very extreme and
causes worry for parents, consult a health professional.
• A Scoliosis (curve to the side) can be easily detected if:
- The hands do not fall easily to the side
- One shoulder may be seen to be raised or
- Carried slightly in front of the other
• Round shoulders are a common complaint in children
and are usually accompanied by a poking chin.
It is important to look at the child's overall stance and encourage
good posture.
BACK C ARE FOR CH ILDREN
36
Sitting Posture
Since children's growth rates are not standard, desks and chairs
of different heights should be available - for example, small,
medium and large.
A correct sitting position allows the child to have his/her feet on
the ground, knees slightly higher than the hips and the lower back
supported when sitting upright. Shoulders should be held down
with head and chin in.
The height of the desk should allow the child to write with the
angle of the elbow at 90 degrees plus.
WALKING
Watch for the following in a child's walk:
• In-toeing and out-toeing
• Scissors gait (walk), that is one foot crossing in front of the other.
• A waddling walk
• Overswinging of the arms
• Limp
If the child's posture does not improve on any of the above points
with encouragement, refer the child to a health professional.
BACK C ARE FOR CH ILDREN
37
LYING
The most common cause of back ache in children or adolescence is
sleeping face down and usually on a soft bed.
Encourage the child to lie on his side with one or both knees bent in
front. Lying on the back with the knees bent is equally as good and a
firm bed is very important.
LIFTING
Young Children automatically squat, for example, when picking up
toys. This is the ideal and should be encouraged as the child gets
older. Older children should be encouraged to use the basic principles
for lifting as stated on page 17.
BACK C ARE FOR CH ILDREN
38
RECREATION
Recreational activities should incorporate full body movement and
can be ensured by participating in a wide variety of games.
While gymnastics are to be encouraged, the exercise of toe-touching
in a standing position should be avoided because:
• It does not come naturally in this part of the world.
• It overstretches ligaments and tendons in the back and
only marginally stretches the hamstrings.
• Returning to the upright position, puts undue strain on the
muscles of the back and predisposes to a slipped disc.
(The following is an abridged version of the Midland Health Board's
leaflet on School Bags).
SCHOOLBAGS
Most children carry their schoolbags incorrectly. Carrying a heavy
load incorrectly, adds extra strain to the back and may result in
back pain in later life. The aim when carrying a heavy bag is to
achieve balance across the shoulders and hips. This means that
the child's posture is distorted as little as possible and the load
is distributed equally.
• A well fitting backpack/rucksack with hip straps is ideally
suited for carrying the heaviest load.
• Rucksacks and backpacks should be worn over both shoulders
with hip straps closed across the waist.
• Rather than one very heavy bag with one hand,
children should carry two smaller loads - one in each hand.
BACK C ARE FOR CH ILDREN
39
YOU PLAY THE BIGGEST PART IN HELPING
TO PREVENT BACK PROBLEMS.
Be aware of your posture at all times no matter what you are doing
and be responsible for adapting your work and leisure positions and
your furniture to suit your back where possible.
POSITIVE GUIDE TO BACK CARE
Pay attention to your posture
• Choose a chair or seat that gives firm support to your spine,
especially the small of your back, whether you are sitting at
home or driving the car.
• Use a firm bed. What is underneath is more important
than the mattress itself. Adopt a good sleeping position.
• Make sure your working surfaces are at the correct height
when either sitting or standing.
• If you must lift, lift as instructed on page 17 of this book.
• Divide the load when carrying, or if possible use a trolley.
• Keep your own bodyweight under control. Make sure you
get a reasonable amount of exercise every day.
• Be aware of safety as falls or sudden jolts may damage your back.
Remember, most back pain need never occur if you take sensible
precautions against it. Not all backpain is serious.
SUMMARY
40
There are a number of publications (published by the Health and
Safety Authority, 10 Hogan Place, Dublin 2 - Tel. 6147000) which
detail the guidelines regarding care of the back in several settings:
Safety, Health and Welfare at Work (General Application) Regulations,
1993 and Guidelines
Handle with Care - Safe Manual Handling
Guidelines on the Health & Safety of Office Workers
Caring with Minimal Lifting - A Safety & Health Guide for those
who care for Patients.
Stay Safe on Site
Pregnant at Work - A Guide to the Safety Health & Welfare
(Pregnant Employees etc) Regulations, 1994.
Farm Safety Handbook
VDU Regulations - An easy Guide for Employees
USEFUL PUBL IC AT IONS
The Health Promotion Unit, Department of Health & Children,
Hawkins House, Dublin 2. Tel: (01) 635 4000
www.healthpromotion.ie
ISBN 0 856387 038 4 03/01
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